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Prescriber Update Articles

Paracetamol toxicity in children - let's reduce the risk

Web site: June 2011
Prescriber Update 2011;32(2):11

Reports over the last 12 months describing serious adverse reactions in children due to paracetamol toxicity highlight the importance of using this medicine appropriately. Paracetamol liquid remains one of the most commonly used medicines for minor illnesses in children. However toxicity can easily occur if there is confusion over the strength of paracetamol liquid used or the need to calculate or measure the dose.

National Poisons Centre data suggests the number of unintentional chronic overdoses involving paracetamol has increased in children over the last five years. A further breakdown by age indicates this increase is greatest in children aged 0-2 years.

The risk of unintentional overdosing in children can be reduced by:

• Prescribing small volumes of paracetamol liquid to be dispensed. Young children are likely to be most at risk of chronic overdosing due to rapidly changing weight, variability in weight versus age, and wide dosing ranges.
• Prescribing paracetamol for each child rather than providing a large volume of liquid for several children or an entire family.
• Reducing the need for parents to calculate doses and convert to the number of mL to administer. A specific dose should always be stated on the prescription.

Healthcare professionals are reminded to inform parents that paracetamol should only be given to children for the treatment of pain and pyrexia, and to ensure the correct dose is given at the correct frequency. Prescribers are also advised to consider limiting the volume of paracetamol liquid prescribed to children to a maximum of 200mL per dispensing. This approach may help to reduce the number of poisonings needing hospitalisation and will reduce the risk of parents using expired medicine.